Wiki Tavi procedure

[kproctor]

I billed the 0256T for our surgeon and we got paid by M/care, but the cardiologist is wanting us to refund M/care so he can get paid. Not sure if I should have billed differently, I know a mod 62 cannot be used with this code. Does anyone know how this procedure should be billed for all the different physicians. thanks

 

[SEARNEST]

We have done about 10 of these. I bill 0256T-80 for our doc, in addition to the femoral access cutdown or femoral endarterectomy. The cardiologist bills 0256T as the primary surgeon. Only one payor has paid our claims with no problem (Capital BC Medicare Advantage plan). Medicare routinely denies our claims for medical necessity and we have submitted appeals. No response on any of these appeals; they are taking much longer than usual. Hope that helps.

 

[jewlz0879]

For Transapical you would bill 0257T and 0258T/0259T if bypass was performed.

For Transfemoral you would bill 0256T. No bypass code would be necessary because this is an Endovascular approach.

When our surgeons perform Transapical we bill;
Surgeon: 0257T and the respective bypass code 0258Tor0259T
Cardiologist: our cardio's are Assistants so we bill with -80 modifier or -62 if done documented accordingly with seperate and disctinct reports reflecting each physicians part.

We are Trailblazer Medicare and these are starting to get paid but we've had to do a lot of leg work and appeals. I think the Transfemoral approach is supposed to have an assigned CPT code come Jan 13'.

 

[slhunter51]

What was the payment you received from Medicare for 0256T?